Reflections on Breast Cancer Awareness Month

Posted byNurture ColumbusPosted inAdvocacy, Breast Cancer Awareness Month, breastfeeding support, insurance coverage, lactation care, Maternal Health, Nurture Columbus Lactation Services, public healthTags:

Allyson Wessells, PT, MPT, IBCLC

Breast Function:

Breast Cancer Awareness Month continues to be important for awareness of the most commonly diagnosed cancer among women in the United States. Understanding the function of the breast and its relation to disease prevention is equally important. The breast can be considered an organ of the immune system uniquely transforming beyond pregnancy to nourish a new human with vital nutrients and antibodies, among thousands of other protective factors.1  Longer duration of breastfeeding is associated with optimizing a child’s physical and mental health for a lifetime ahead while also reducing a mother’s risk for many diseases, including breast cancer.2,3,4 Awareness of human milk as species specific nourishment that equips our immune systems to better defend our bodies is something everyone should promote. Mothers who choose to breastfeed should have easy access to skilled lactation care and community support proven to help meet breastfeeding goals, improve maternal and infant health outcomes, and contain healthcare costs.5,6,7

Lactation Care Access:

Government health policy leaders promote breastfeeding and recommend it for at least 1-2 years for its advantages to mothers, babies and society.8 Equitable access to and coverage for skilled lactation care to assist in achieving recommendations lags, especially within state Medicaid plans.9 This is despite a 2013 Affordable Care Act (ACA) provision to contain cost and improve health outcomes through health plan coverage for comprehensive lactation care.9 Direct advocacy with the Ohio Department of Medicaid (ODM) ultimately revealed inability to reimburse the most advanced level of care for breast function, the International Board Certified Lactation Consultant (IBCLC), due to a lack of state licensure for this credential.10 Many private insurers recognize and reimburse this provider with oversight through the International Board of Lactation Consultant Examiners (IBLCE).11 Efforts to establish solutions for ODM recognition are underway but licensure requires legislators to introduce a bill to license IBCLCs, passage through a complex General Assembly, and a state board to oversee the licensure.

Local Service:

Reimbursement is important to sustaining credible, evidence-based IBCLC care. Private health plan coverage for Nurture Columbus IBCLCs has grown the volume of families accessing our services and achieving their goals such that the Nurture team is expanding! We hope public health plan reimbursement becomes proportional so the IBCLC field can grow across diverse communities and more equitably fulfill a mission to reduce socioeconomic and racial health disparities, including breast cancer rates, through better access to care that improves breastfeeding rates.12 There can be many barriers to successful breastfeeding, but public health plan coverage for IBCLC care should not be one when breast cancer prevention is a most prominent goal of this important month of awareness.

At Nurture, we hold all who have been affected by breast cancer close to our hearts, and strive to be a small part of reducing cancer risk by helping people reach their breastfeeding goals💗

References

  1. Ballard O, Morrow AL. Human milk composition: nutrients and bioactive factors. Pediatr Clin North Am. 2013 Feb;60(1):49-74.
  2. Czosnykowska-Łukacka M, Lis-Kuberka J, Królak-Olejnik B, Orczyk-Pawiłowicz M. Changes in Human Milk Immunoglobulin Profile During Prolonged Lactation. Front Pediatr. 2020;8:428. Published 2020 Aug 7.
  3. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease. Lancet. 2002 Jul 20;360(9328):187-95.
  4. Anstey EH, Shoemaker ML, Barrera CM, O’Neil ME, Verma AB, Holman DM. Breastfeeding and Breast Cancer Risk Reduction: Implications for Black Mothers. Am J Prev Med. 2017;53(3S1):S40-S46.
  5. Wouk K, Chetwynd E, Vitaglione T, Sullivan C. Improving Access to Medical Lactation Support and Counseling: Building the Case for Medicaid Reimbursement. Matern Child Health J. 2017 Apr;21(4):836-844
  6. Ware JL, Love D, Ladipo J, Paddy K, Starr M, Gilliam J, Miles N, Leatherwood S, Reese L, Baker T. African American Breastfeeding Peer Support: All Moms Empowered to Nurse. Breastfeed Med. 2021 Feb;16(2):156-164.
  7. Dylan D Walters, Linh T H Phan, Roger Mathisen, The cost of not breastfeeding: global results from a new tool, Health Policy and Planning, Volume 34, Issue 6, July 2019, Pages 407–417.
  8. Office of the Surgeon General (US); Centers for Disease Control and Prevention (US); Office on Women’s Health (US). The Surgeon General’s Call to Action to Support Breastfeeding. Rockville (MD): Office of the Surgeon General (US); 2011. PMID: 21452448.
  9. Hawkins SS, Dow-Fleisner S, Noble A. Breastfeeding and the Affordable Care Act. Pediatr Clin North Am. 2015;62(5):1071-1091. doi:10.1016/j.pcl.2015.05.002
  10. Wessells, A., Smith, C., Gladney, J. Lactation Care: Advocating for Equitable Access at the Ohio Department of Medicaid. Clinical Lactation. (2020) Volume 11, Issue 3.
  11. International Board of Lactation Consultant Examiners (2018). Scope of Practice and Clinical Competencies for IBCLCs. https://iblce.org/resources/professional-standards/
  12. Chetwynd EM, Wasser HM, Poole C. Breastfeeding Support Interventions by International Board Certified Lactation Consultants: A Systemic Review and Meta-Analysis. J Hum Lact. 2019 Aug;35(3):424-440.

About the author: Allyson Wessells is a physical therapist and International Board Certified Lactation Consultant (IBCLC) with Nurture Columbus, in Columbus, Ohio. As a PT and IBCLC, she focuses on optimizing nourishment and growth for lifelong health. Other services include presentations emphasizing the importance of breastfeeding and infant neurodevelopment as foundations for preventative healthcare.

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